SUMMARY

• Have 12 years of experience in Business Requirements Modeling, Business Process Analysis, and Client/Server applications for enhancing the business processes.
• In - depth knowledge of Retail, Pharmaceutical & Medical and Healthcare organization operations including outsourced operations, Health Insurance, HIPAA, and Medicaid/MMIS, including MITA.
• Expertise in Project Planning, Project Design, creating functional specifications and data flow diagrams.
• Software Developer - MIS Support &SQLQueriesReport Analysis - Client Confidential
• Expertise in translating user requirements into technical specifications and mapping the process design, work flows for SDLC with documenting and managing business requirements.
• Possess excellent organizational, interpersonal, communication and documentation skills with good process management skills along with a remarkable ability to gather requirements to bring out quality product.
• Expert level skills in Java, JSP, Servest, Struts, JUNIT, Multithreading, JDBC.
• Mentored other team members on the development & support of HL7 interfaces for clinical applications.
• Knowledge of HL7 and/or X12 standards, segments and fields required
• Strong background of analysis of HL7 and / or X12 workflow documentation
• Solid QNXT experience that includes participation in all phases of EMR implementation; project planning, workflow analysis, design, build, validate (DBV), “go-Live” training delivery, on-site support, and post go-live optimization.
• Extensive experience in gathering requirements and estimate effort for HL7 interfaces.
• Experience in developing of web-based applications
• Extensively worked with different X12 Hierarchical Levels (HL structures) in various inbound claim/inquiry-response transactions (837 P/I/D, 270/271, 276/277).
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets
• Worked on development and implementation of policies, procedures and QA methodologies
• Gathered requirements to check HIPPA- eligible & participation check for individual coverage.
• Technical and business knowledge in multiple disciplines/processes.
• Strong understanding of HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834- Enrollment /Dis-enrollment to a health plan, 835, 837 ...etc.)
• Possess strong analytical and problem-solving skills with the ability to adapt to a new environment and meet stringent deadlines.
• Ability to successfully manage multiple deadlines and multiple projects effectively through a combination of business and technical skills.

TECHNICAL SKILLS

Methodologies: Agile, Waterfall

Requirement management tools: QC, Rally Dev, Jira

Project management tools: MS Project, Sharepoint

Business Modelling: MS Visio

Web technologies/languages: SQL, C++, XML,Java

Front-End tools: Microsoft Excel, Word, Power Point SharePoint

Database & BI: MS SQL Server, Oracle, SSIS, SSAS, SSRS

Operation system/platform: MS Windows 2010, 2008, 2003/XP/2000/NT

Applications: QNXT, Facets, Track Wise

PROFESSIONAL EXPERIENCE

Confidential, Birmingham, AL

Business System Analyst

Responsibilities:

• Worked on QNXT including Claim processing (online and batch adjudication), Case management, Customer service, Member/subscriber administration, Provider network management and reporting.
• This data may be generated as results returned by StructuredQuery Language (SQL) or as pictorials, graphs or complex results, e.g., trend analyses from data-mining tools.
• Responsible for UAT project planning and Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes and conducted research on IT requirements andbusinessrequirements in UAT areas.
• Today almost all RDBMS (My Sql, Oracle, Informix, Sybase, and MS Access) useSQL Queriesas the standard databasequerylanguage.SQLis used to perform all types of data operations in RDBMS.
• Experience in writing T-SQLQueries, Stored Procedures, Functions, Joins, and Views etc.
• Providing backend support for CRMS (Customer Relationship Management System), Payroll & TDS Systems throughSQLQueries, Crystal Reports & MS Excel & Access.
• Experience in creating cubes with dimensions and facts tables in Warehouse usingSQLServer Analysis Services (SSAS).
• Creating and Modifying T-SQLstored procedures for validating the integrity of the data.
• Quantumparticles such as atoms and molecules have an uncanny ability to appear in two places at once, spin clockwise and anticlockwise at the same time, or instantaneously influence each other when they are half a universe apart.
• Programmed is also an attempt to provide an opportunity for SSA improving human capabilities to all children through provision of community -owned quality education in a mission mode.
• SQLstatements areused toperform tasks such as update data on a database, or retrieve data from a database.
• Facilitate the modification and development of existingSSAprograms as well as accountable for the creation of new programs usingSASMacros.
• StrongMainframedevelopment experience which includes requirement gathering, technical discussion with Products owner, design finalization, coding (Build), unit testing and scrum testing support.
• Created customized existingreportsusing cross-tabreports, sub-reportsand charts by usingCrystalreportsXI.
• SetupRPA/Automation COE from scratch using Pega Open span, Pega Robot manager.
• Expert inRPA-Automationdevelopment with the toolAutomationAnywhere and Good Knowledge on UI Path.
• Code design usingmainframe(COBOL, JCL, DB2, and VSAM) and ISPF, SQL commands, Sabre GDS file Aid, File Manager, Endeavor, and Easyrrieve.
• Implemented business layer using Core java, Sabre GDS Spring Beans using dependency injection, spring annotations.
• Executed Test Cases inFacetsutilizing TFS and MTM.
• Designed end to end process solution forInformatics.
• Created pre SQL and post SQL scripts which need to be run atInformaticslevel.
• Validated claims pricing inFacetsvia Westar/Group prices andFacetspricing.
• Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
• Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files to ensure required interactions are met during the SDLC process.
• Validated Inbound and outbound 837 transactions, including but not limited to the loading and correcting any errors with the process of EDI inbound and outbound files
• Validated outbound 835 transactions including but not limited with vendor on QNXT mapping and system configuration.
• Business Process Analysis/End User Education/Business Requirements Documentation
• Validated System configuration, including enrolment, provider and benefits modules
• Creation of queries and reports to assist Health Plan Operations with the analysis of data relating to claims, members and providers.
• Content analysis, structured data modeling and mapping: Designed and developed data definitions for schema from multiple data sources and relational database into newXMLformat.
• Executed Test Cases viaFacets5.01 against the Benefit Matrix utilizing Rapid SQL queries.
• Analyzedbusinessrequirements and generatingUXwires for review and development
• Worked with the Business Representative to understand requirements and priorities and ensure that building of pharmacy claims processing system was aligned appropriately.
• Created project plan and WBS using MS project and JIRA (during design, development and testing phases).
• Updated the pharmacy retail locations to the ETL table and worked with HIPAA X12 EDI transactions (834, 837)
• Worked closely with ETL leads/Managers and performed data requirements analysis and documenting the analysis.
• Execution of daily, weekly and monthly reports and processes and the creation of ad-hoc reports.
• Broad knowledge of CCHP departmental processes, procedures and data.

Environment: Java/J2ee,QNXT, RUP, Rational Rose, XML,Requisite Pro,Facets, MS Visio, RUP, MS Project, SQL, Oracle, HTML, XML, CSS, MS Access, MS Excel and MS Word.

Confidential, Portland, OR

Business System Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
• Used Team Foundation Server (TFS) and MTM for defect tracking and maintaining test cases.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Responsible for UAT project planning and Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes and conducted research on IT requirements andbusinessrequirements in UAT areas.
• Developed and implemented the MMIS Third Party Liability (TPL) Subsystem.
• Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance and developed an action plan for approval by the project steering committee.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
• Conducted Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
• Worked on CRM (Customer Relationship Management) project to implement Microsoft Dynamics.
• Worked with the Marketing Management/team members to understanding their needs and requirements in regards to picking the right CRM system.
• Part of the project management team responsible for SWOT analysis.
• Used Scrum Work Pro and Microsoft Office software to perform required job functions and prepare Product back log and sprint back log and conduct all the meetings and discuss and help scrum master.
• Involved in mapping data from SWIFT securities reporting messages.
• Functional andUXdesign of applications and programs.
• Consult teams in need ofUI/UXhelp with their applications.
• Responsible for cost estimation and timelines for various Business Intelligence reports.
• Involved in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
• Used UML and OO discovery methods to perform discovery for new enterprise wide installation of Trizetto FACETS (both core and extension requirements) using Rational Rose.
• Implemented a mechanism to in corporate business-required data which is not in the core Facets system. NFE (Non-Facets Elements) proved to be of major business importance in implementing state-customizations and underwriting, needs not encompassed by the Facets system.
• Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Assisted to develop the Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
• Prepared graphical depictions of User stories, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.

Confidential, Franklin Lakes, NJ

Project Manager / Sr. Business System Analyst

Responsibilities:

• Attended Reliability meetings to escalate any high risk issues to the senior management for immediate attention.
• Key participant on a team responsible for migrating jobs (over 10k) running on a Legacy Platform to a New Platform. The New platform provided more visibility job monitoring and issue resolution.
• Led the initiative on migrating legacy job submission tool to web based which was responsible for processing 100+ data loads for client delivery. Responsible for providing all the requirements and testing and served as the operations lead for testing and certifying all the migrated jobs.
• Worked with analytics and development teams in integrating a third-party processing and presentation tool into our production environment. As a result, the sales team was able to sign up 50+ clients to use this presentation tool. Recipient of the best product documentation award
• Created SOP's wherever necessary to ensure proper training is given to the Customer Service Representatives.
• Worked on closing the production tickets using Remedy.
• Proficient in dealing with Medicare and Medicaid requirements to meet the CMS standards.
• Created Business requirements and discussed the impact with the cross-functional teams using JAD sessions.
• Maintained traceability to ensure all the Business Requirements are transformed into the Functional Requirements.
• Held Peer reviews within the team so everyone is aware of the changes and avoid any duplicate work effort and thus minimize cost over-runs due to rework and scope creep.
• Reviewed Technical Specification Documents (TSD) and made sure all the functional requirements are traced back to the construction level and provided sign-offs.
• Tested software applications for quality, accuracy, user experience (UI/UX), and formatting
• Coordinated with the Data Support Team to provide data both to Dev and QA teams.
• Reviewed the Integration Results (Unit Test) and provide sign-off before the code can be moved from Integration to QA Environment.
• Reviewed Quality Test Cases (QTC's) and Quality Test Outputs (QTO's) with the QA team and provided sign-offs
• Tracked the defects using Clear Quest and held daily meetings to ensure their closure and to avoid jeopardizing the timelines.

Environment: SQL, MS Word, Excel, Access, Clear Quest, Requisite Pro, GEM, MS Visio, JIRA, SharePoint.

Confidential, Dover, DE

Business Analyst

Responsibilities:

• Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA)
• Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
• Responsible for updating clients with provider information within MMIS on a weekly basis by running queries and exporting data in a defined file formats.
• Thorough knowledge of ICD 10 codes and CPT codes for both Mental and Medical Health and worked extensively with Inbound and outbound 834 Transactions processing systems.
• Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.
• Created, altered and implemented T-SQL Stored Procedures for the use of processing consumer data and developing new web delivered tools.
• Used Data warehousing skills including ETL and end-user access issues.
• Planned the entire Data Warehousing initiative from requirements gathering, analysis, design, identifying and analyzing the source systems, to data quality, to ETL, and to the end user data access.
• Provided release management strategy checklists and change management techniques.
• Presented and assisted end users for education and training about the new system.
• Generated reports using SQL Server Reporting Services (SSRS), and MS Excel spreadsheets.
• Involved in Source Data Analysis, analysis and design mappings for data extraction.
• Also responsible for Design and Development of SSIS Packages to load the Data from various Databases and Files.
• Design, deploy, and maintain various SSRS Reports in SQL Server 2012.
• Collaborate with federal clients (CMS, NIH, ONC) and standards development organizations such as HL7 to develop
• Responsible for UAT project planning and Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes and conducted research on IT requirements andbusinessrequirements in UAT areas.
• Validated Test Cases and Execute test cases inCURUMfor UAT Test Scenario.
• Assisted JAD sessions to identify thebusinessflows and determine whether any current or proposed systems are impacted by theEDIX12 Transaction, Code set and Identifier aspects of HIPAA.
• Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA)
• Developed Schemas ofEDIX12 Claims (837) and Eligibility forms in XML. Involved in creating sample mappings for the conversion ofEDIX12 transactions code sets.
• Lead SCHIP, CMS request to be able to identify the Medicare eligible candidates.
• Generated and maintained SQL Scripts to perform back-end testing on the oracle database. Produced customer functions, complicate SQL commands inBusinessObject Enterprise XIR2 and Oracle 10g, Crystal Reports XI environments.
• Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.
• Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review and RX eligibility.
• Troubleshooting utilizing CPT4 & ICD 10 codes and Managed HL7 interfaces for PM/EHR software and Lab computers and performed requirements gathering,businessprocess mapping and re-engineering as a part of health exchange readiness efforts for leading public health plan entering state HIX market.
• Involved in projects to design a state-customized Financial Management solution for Health Insurance Exchange (HIX)
• Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
• DevelopedEDIspecifications and applications structures for data feeds and mappings for integration between various systems, including XML and performed back-end testing on the Oracle database by writing SQL queries.
• Handle the tasks of helping the organization staff in planning data sets for UAT.
• Created Test Strategy Planning (TSP) and assisted testing team to implement test plans during UAT kickoff.

Environment: SQL, MS Word, Excel, Access, Oracle, DB2, Lotus Notes, File Viewer, Web Client, Clear Quest, Requisite Pro, GEM, MS Visio, SharePoint.

Confidential, Roanoke, VA

Business Analyst

Responsibilities:

• Identified processes for developing and documenting detailed business requirements. Data was collected from end-users, and analysts.
• Created Use-Cases and Requirements documents to document business needs.
• Requirements were gathered through interactions and meetings and periodic walkthroughs with loan analysts, credit analysts and other potential users of the application.
• Conducted Use-Case reviews and identified gaps, leading to improvements/enhancements in the same.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked on Guidewire, extensively worked on Guidewire Policy center & Guidewire Claim Center
• Used GuideWire software to track the claims of the policyholders.
• Guidewire was specifically used by the team to implement the enhancement to expedite the claim process for unregistered users
• Used Guidewire to upgrade the current Claim system to track the claim of the policyholders and third party applications
• Involved with the testing team to check the augmentations done previously using Guidewire.
• Ensured Use-Cases were consistent and covered all aspects of the Requirements document.
• Maintained documents and the effect of proposed changes on the project schedule and costs.
• Used Rational Clear Quest for bug reporting.
• Documented the Use Cases and Activity diagram worked on COTS Integration and Application Architecture design. Created and maintained workflow plans and business process flows using MS Visio 2013.
• Worked directly with software engineers to ensure clear communications on requirements and defect reports.
• Designed and developed scenarios based on business requirements.
• Developed requirements integrating E-R diagrams and designed the testing process flows.
• Followed the RUP methodology for the entire SDLC.
• Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Software Development Life Cycle.
• Interacting with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues.
• Validated the scripts to make sure they have been executed correctly and meets the scenario description.

Environment: Windows2000, Rational Rose, Guidewire, Rational Unified Process, Rational Clear Quest, Oracle, and Microsoft Project 2000.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Performed stakeholder analysis to identify key players for project success
• Identified and involved all key stakeholders, contributors, business, operations and technical resources that must participate in a project and ensured that contributors are motivated to complete assigned tasks within the parameters of the project plan.
• Experience in Merchandising, Pricing, Campaign Management, Content Management Systems.
• Prepared interview questionnaires for the clients to gather requirements.
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Collected and documented business processes as well as business rules. Provided key input in working with users in defining project and system requirements.
• Performed Testing in Airline Retail/E-Commerce projects with different browsers and iO/S
• Executed SQL queries and documented them as part of validating the Business Object reports and for testing purposes.
• Responsible in authoring the functional specification documents, data architecture designs for setting up customized receipt management and revenue adjustment modules in the ERP application.
• Responsible for maintaining and enhancing the ERP application according to the changing business requirements.
• Worked with UAT team and Managers during requirement enhancement sessions.
• Wrote integration requirements document for common processes, functionality, and business rules between multiple applications.
• Created Use Case diagrams, activity diagrams, State Chart Diagrams according to UML methodology.
• Created Story Boards, Wireframes, mockup screens, User Stories using tools like JIRA, Wireframes, MS Visio.
• Performed validation testing on the application for various scenarios and reported the errors.
• Analyzing User and Functional requirements to point out gaps between used SQL queries to extract the data from the database
• Conducting JAD sessions and gathering software requirements and Business intelligence rules.
• Developed Data Flow, Work Flow, Process Flow, and Entity Relationship Diagrams in MS Visio, and analyzed them.
• Documented the System Specifications Document and performed Integration and Regression testing along with testers.
• Collaborated with Quality Assurance Analysts to track defects.

Confidential, Cincinnati, OH

Business System Analyst

Responsibilities:

• Communicated with the stakeholders to understand the scope of the project, gathered and documented the requirements.
• Interviewed the SME’s and carefully recorded the requirements by asking detailed questions and documented all the requirements so that they could be understood by both business people and technical teams.
• Created the user requirement specifications and helped convert them to functional requirements, business case and glossary.
• Identified and defined actors, and grouped them into UML Use-Case, Activity and Sequence diagrams in MS Visio.
• Conducted User Acceptance Testing by assisting with Test cases and plans.
• Held walkthroughs with the developers and QA teams in order to communicate enhancement requests and to answer and clear all their queries.
• Used Test Director to manage and track defects, prioritized defects with each build and made sure that they were communicated to the appropriate teams.
• Maintained requirements traceability in order to keep all the teams up-to-date with the progress of the project.
• Initiating and leading meetings to coordinate workshops gather and document requirements.
• Ensure meetings remain on task and any necessary decisions are made, able to ask the right questions to guide discussions, ensuring desired outcomes.
• Created test cases for System Testing (Development Environment), Integration Testing (UAT) and Production (Post Implementation Review) in Agile environment.
• Worked as a Business Analyst in implementation of security login authentication and authorization, and application upgrades on 17 on-line self-service e-commerce, B2B, and B2C e-commerce financial applications.
• Collaborate with external BAs to develop portals into external company web sites, enhance existing applications and processes and retire obsolete or redundant processes.
• Streamline user interfaces, created and updated Wireframes, enable users and update overall look and appeal to web sites.
• Responsible for gaining a good understanding of user needs and accurately representing them in a well-documented software functional specifications document.
• Designed, developed, implemented and debug message sets, My SQL code and message flows.
• Worked with QA team for creating test plans, test scripts and participated.
• Involved in developing Test plan and Test cases based on Use cases and Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies

Confidential, Dallas, TX

Business Analyst

Responsibilities:

• Analyzed and documented the System specifications, Business Requests and detail design of the software for full understanding of the business practices.
• Worked according to the activities/roles laid down in each phase of software life cycle and helped in design of applications for loan management
• Created Use Case models, Use Case Diagrams, Sequence Diagrams and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping.
• Prepared and analyzed AS IS and TO BE workflow scenarios and performed Gap Analysis, designed new process flows and documented the business process.
• Facilitated in conducting JAD sessions, Test planning, Test execution and Data validation.
• Understanding of application development and software development life cycle concepts
• Facilitated JRP to identify the business rules and requirements.
• Participated in project team reviews to review test cases, develop test cases, test approaches, Testing applications, documentation and other specifications throughout the project.
• Developed test cases, created test plans, data analysis and coordinated the overall test execution.
• Performed Regression and E2E testing, and UAT
• Actively participated in Kick-Off meetings to get a better understanding of the project scope and requirements.
• Extensively gathered requirements from Business Users and SME's to understand the current functionality and assess the user needs.
• Implemented RUP's iterative approach, which allowed increasing understanding of the problem through successive refinements.

Environment: Windows XP, MS Office, System testing, MS Visio, SDLC, UAT.